Saturday, November 14, 2009

Mom's awake and showering. She greeted me with a dull nod when I saw her; her affect-- i.e., her emotive capacity-- remains more blunted than usual. There's no smiling, no frowning, nothing. Although we've gotten used to seeing Mom in a "bland" state ever since her first surgery, she's had moments where she laughs or smiles. Since Tuesday, though, Mom's look might best be described as bored or depressed or exhausted. There's something hangdog about her demeanor that seems oddly appropriate for the cloudy and rainy fall weather we've been experiencing. I've been wondering whether she's depressed and in need of more stimuli. Most of her Korean friends have stopped visiting, except for Mrs. Merrill, who had made a point of routinely dropping by on Mondays to see Mom. But Mrs. Merrill will be away for several weeks because of surgery, so the visitor schedule promises to be more sparse and erratic than usual.

To address the issues of exercise and the need for stimuli, we'll be taking Mom out today, either to Pentagon City or to Fort Hunt Park, to make up for our failed attempt to go out a few days ago. Mom needs a chance to walk around and see the sights. We'll also be exercising Mom's lungs with the incentive spirometer, and even though she's going to be walking today, we'll be making her do heel raises, squats, and whatever else we can think of to work her legs.

I continue to worry that Mom's edema is new, and is the result of increased tumor growth. Her next MRI is six weeks away, but we've seen what can happen when a tumor is given eight weeks to grow. Mom's third tumor may very well be growing through her carboplatin treatment; it's hard to say. I'm not sure how happy I am with carboplatin in general; it feels like a step backward instead of a step forward. Carboplatin is an older drug and has been around a long time. It has been in use for brain tumors far longer than Avastin; the latter was approved for brain cancer only this past May. Carboplatin's method of interaction with cancer isn't as well-understood as it should be, and to make matters worse, a patient can lose a lot of carboplatin through urine, thereby diminishing whatever therapeutic ability the drug has. Mom's on a diuretic, which makes me wonder how much carboplatin she's actually retaining.

At the same time, Mom's had only one infusion of carboplatin, which makes it difficult to evaluate the situation. The eternal frustration for a cancer patient is that, when you embark on a certain course of therapy, you have to stick with it to see whether it's effective. Effectiveness is rarely instantaneous. So the gamble for Mom is that (a) the carboplatin is effective, but will need the full eight weeks to show this; or (b) the carboplatin is ineffective, and Mom's tumors will have had eight weeks to grow largely unimpeded. Because this is brain cancer, and because Mom's first surgery rendered her incapable of making important decisions for herself, the agony of choice falls to the rest of the family, especially to Dad and me.

My mind occasionally creeps back to the aggressive treatment options available at far-off hospitals like MD Anderson and Duke University Comprehensive Cancer Center. But the original reason we opted not to try those places is still in force: Mom's home, family, and primary circle of care is here, in northern Virginia, and NCI is also one of the foremost research centers for cancer out there. Even if we did elect to move Mom to a far-off hospital, we'd still be facing the same gamble: a treatment regimen that would last weeks or months, and whose outcome couldn't be definitively known until the treatment had finished.

Anyway, Mom's up today. She's done showering and is brushing her teeth, and even though she doesn't know it yet, she's got an active day ahead of her. I suppose that's something to be thankful for.